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According to Deidre Murphy and Jennifer Walsh, two Obstetricians from Dublin, even small changes in Body Mass Index (BMI) between pregnancies can affect health. Mothers who put on or lose a lot of weight between pregnancies are putting themselves and their babies at risk.

A two unit increase in BMI doubles the risk of having a large baby, high blood pressure and pre-eclampsia. Larger increase adds to this risk and there is a greater risk of stillbirth and other complications.

Losing weight, on the other hand, increases the risk of having premature babies or low birth weight babies.

Their message is clear. Maintain a healthy weight before, during and after pregnancy and remain at the same weight before the next pregnancy.

Dr. Walsh said, “Women of reproductive age are bombarded with messages about diet, weight and body image. There is growing concern on the one hand about an epidemic of obesity, and on the other about a culture that promotes ’size zero’ as desirable, irrespective of a woman’s natural build.

Pregnancy is one of the most nutritionally demanding periods of a woman’s life, with an adequate supply of nutrients essential to support foetal well-being and growth.

With at least half of all pregnancies unplanned, women need to be aware of the implications of their weight for pregnancy, birth and the health of their babies.”

Their review cited the Swedish Study of 207,534 women between 1992 and 2001 and assessed the link between BMI changes and the impact on the pregnancy and the mother’s health.

Tam Fry, member of the National Obesity Forum said, “I think these doctors are absolutely right.”
He said that being overweight is also associated with Polycystic Ovary Syndrome. This can result if difficulty in conceiving.

Women should be aiming for a normal weight before they have their second child.

Dr. Phil Hariram.
Diet and Pregnancy.

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Herbs are considered natural remedies and can be bought over the counter. The impression is that because they are just herbs, they are safe. This is not always the case.

During pregnancy you have to be very careful. Some herbs can cause miscarriage, raise your blood pressure or affect your baby. My opinion is that you do not take herbal medicine during pregnancy. Ginger, however, is one I recommend. If you are tempted, ask your doctor first. Do not listen to advice at health food shops or herbalists. These herbs are not tested and no one can guarantee their safety in pregnancy.

Some herbs we know can cause problems during pregnancy. The others we know very little of their potential to harm.

Ginger is a herb used in cooking but it can help GERD. It can stimulate saliva production in the mouth. Saliva is a natural antacid. It works well in heartburn of pregnancy, helps relieve nausea and vomiting and it is a carminative (relieve gas). It has been used for centuries to control nausea and vomiting.

Ginger is available as a powder, juice, oil or in capsules. My recommendation is to use a small amount of fresh ginger mixed in your food. Avoid ginger supplements in pregnancy and make sure you know how much ginger you can safely take in a 24 hour time frame.

A review of six double blind controlled trials was published in 2005. The study involved 675 pregnant women with GERD. The study provided evidence that ginger is effective in relieving nausea and vomiting during pregnancy. Ginger also has no significant side effects or potential harm to the foetus.

If you are keen to avoid medication for GERD in pregnancy, use a small amount of fresh ginger in your food. It is safe and adds flavour to your food.

Dr. Phil Hariram.

Yoga is a combination of exercises that relaxes the body and help digestion. The breathing exercises and various techniques employed relax muscles and reduce stress. Yoga experts suggest that during meals you eat slowly and chew properly to promote good digestion. In between bites you should take a deep breath.

Do not practice yoga soon after meals. It will make your GERD worse. Wait for about three hours. Select the exercises that will not put added pressure on your abdomen. This will aggravate GERD. Choose the exercises that keep you upright and avoid unnecessary bending. Yoga is a good discipline to use during pregnancy.

Reflexology involves working on particular part of the foot to promote balance or normality in various organs of the body. The esophagus and the stomach are included in the map of the foot, The stomach is in the middle of the sole of the foot and the esophagus is on the sole right behind the big toe. The diaphragm is just in front of the stomach area. Proponents of the therapy will work in these areas of the foot to treat GERD.

Juice therapy is used in treating GERD. It is safe in pregnancy. The juice is a mixture of fruits added into a juicer and the extracted juice is drunk. One recipe includes one quarter pineapple, one kiwi fruit, one quarter of an inch of fresh ginger crushed. Some suggest adding fresh mint leaves but mint can relax the Lower Esophageal Sphincter.

The ingredient that produces the real benefit is ginger. In pregnancy you should not exceed the recommended daily intake, so you are restricted to 8 ounces of the juice.

Dr. Phil Hariram.

In pregnancy, you must know what is safe and what is not when treating your GERD. Before your pregnancy you could try any one of the various alternative treatment available but extreme care during pregnancy is very important.

Homeopathy uses the concept of like heals like. The use of the drugs in homeopathy in pregnancy is questionable. Personally I think you should stay clear of these drugs. They have not undergone stringent testing expected in conventional drugs prescribed by your doctor. Even in most prescribed drugs the safety in pregnancy is not clear. This is because of the ethical issues using pregnant mums in trials.

Acupressure and acupuncture today uses sterile disposable needles to stimulate acupoints in the meridians of the body. Acupuncture is safe during pregnancy and does not injure the foetus. Acupuncture is used in many areas of treatment but I am not convinced there is any significant benefit in GERD.

Aromatherapy uses essential oils and reduces stress. This helps GERD because it is assumed that GERD sufferers have a high level of stress. It is not a proven therapy and some of the oils can be absorbed through the skin and reach the blood stream. In pregnancy do not use aromatherapy unless guided by your doctor.

Ayurvedic medicine uses a combination of herbs as part of a holistic approach to the treatment of GERD. These herbs have not been tested for safety in pregnancy. If you are considering using Ayurvedic treatment during pregnancy get professional help first. You can, however, use the other aspect of this treatment and avoid the herbs.

Dr. Phil Hariram.

Omeprazole is a proton pump inhibitor. This group of drugs work by reducing acid secretion in the stomach. They are put in Category B by the FDA except Omeprazole which is in Category C.

The proton pump inhibitors in Category B are esomeprazole, lansaprazole, pantoprazole and rabeprazole. Omeprazole is in Category C because there is insufficient human studies and a trial that used doses up to 69 times the normal human dose caused death of the foetus in rats and rabbits. There has also been rare reports of congenital defects in infants of mothers who used omeprazole during pregnancy. There is, however, no clear evidence that omeprazole was the cause.

Although these drugs cross the placental barrier there is no suggestion that they can cause harm to the foetus.

Unless your symptoms are severe, do not take any medication during pregnancy. Be careful with any medication you take during pregnancy. If you have to take any medication, be guided by your doctor.

Dr. Phil Hariram.

Antacids are generally regarded as safe but should you use them in pregnancy? Most antacids are safe during pregnancy but before you take any antacids consult your doctor.

All antacids work by neutralising acid in the stomach so that the refluxate in the esophagus is less acidic and unlikely to cause heartburn.

Antacids do not cross the placental barrier. In other words it does not get into the blood circulation of the foetus. They, therefore, cannot harm the baby. They are all grouped in Category A. Drugs in this group will not injure the foetus.

Avoid antacids containing sodium bicarbonate. The high sodium content could cause fluid retention. It can also trigger secondary acid secretion and make problems with gas worse.

Antacids containing magnesium can delay, slow down or stop labour. Aluminium containing antacids can make constipation during pregnancy worse.

Dr. Phil Hariram

The lifestyle change in pregnancy to help control GERD is not much different from other individuals with GERD.

Pregnant women are advised not to smoke or drink alcohol because of the potential risk to the foetus. In addition alcohol and smoking affect the lower esophageal sphincter and encourage acid reflux. If you are still smoking and drinking there are two good reasons to stop.

Elevating the head of the bed is a good idea. GERD is more common in the third trimester. At this stage, a pregnant woman will find it more comfortable to sleep on her back. This is not a good position for GERD. The best position to be when sleeping is on the left side because the stomach is lower than the esophagus. If you catnap during the day, sleep propped up or in the sitting position.

Small frequent meals provide less opportunity for reflux. Avoid food up to 3 hours before going to sleep at night. This way the stomach is relatively empty when retiring.

Certain items in your diet can aggravate GERD. Avoid or use less coffee, chocolate, citrus fruits, tomatoes. Fats reduce gastric emptying time. Eat foods with lower fat content. Avoid spicy foods.

Exercise is good in pregnancy but if you have GERD just bending forwards can trigger GERD. Exercises involving bouncing up and down will aggravate your GERD. Stick to exercises that keep you upright. Stretching and power or brisk walking is good and unlikely to aggravate GERD.

Dr. Phil Hariram.

In 1979, the FDA categorised the drugs used in pregnancy based on the safety profile and potential to harm the foetus. The categories are A,B,C,D and X.

Category A: Drugs that have strict controlled trials and have no risk to foetus. In this group are drugs that have an extremely small risk of harm to the foetus. No GERD drug is in this category.

Category B: Drugs found to be safe to animal foetus but no well controlled trials done on pregnant women. Or. Drugs that show harm to animal foetus but trials have not shown problems to human foetus.

Category C: Drugs with no human studies but animal studies show harm to foetus. Or. No animal or human data available.

Category D: Drugs that can possibly harm foetus based on trials and reports of adverse events.

Category X: These drugs are known to damage the foetus in both animals and humans.

Drugs in category X should never be used in pregnancy.

Category D should be used when the benefits outweigh the risk.

Dr. Phil Hariram.

There are two tests commonly used to diagnose GERD. They are X-ray (Barium swallow and meal) and endoscopy.

In pregnancy, however, a careful decision has to be made whether either of these tests are necessary. A decision to carry out such tests in pregnancy must be based on the fact that the need for accurate diagnosis outweigh the potential risk of harm to the foetus.

Personally for GERD symptoms, I do not think there is a need to have either. The risks from x-rays on a developing foetus has been well documented ages ago. No gastro-enterologist would consider this option in pregnancy.

Endoscopy to the lay public seems a safe option in pregnancy but the reality is that to avoid gagging etc. during the procedure, a sedative is given. Since thalidomide, doctors are reluctant to use this group of drugs on pregnant women even if they are in Category A,B or C  by the FDA. Drugs in these categories are considered relatively safe in pregnancy.

As a GP with 27 years experience, I think you should aim to avoid all drugs in pregnancy unless absolutely necessary and if you have to take any medication make sure you are satisfied it is safe.

A GP will reluctantly prescribed a drug for severe vomiting in pregnancy. One drug that was used for over twenty years and considered safe to take during pregnancy, was suddenly withdrawn because of potential side effects on the foetus. Doctors tend to trust the safety profile of a drug the longer it is used and with no reported side effects reported. A lesson I learnt quickly. Do not prescribe in pregnancy unless absolutely necessary.

In pregnancy, avoid drugs if you can.

Dr. Phil Hariram.

80% of pregnant women have GERD symptoms and it is common in the third trimester. The severity can be listed by the increasing level of severity in a spectrum. At one end are the patients with very mild symptoms and as you move along the spectrum the symptoms worsen until you reach the other end where symptoms are extremely severe.

Often patients who have severe GERD in pregnancy have GERD symptoms before falling pregnant. At the severe end of the spectrum, patients can suffer significantly. Some may even need to be hospitalised.

There are occasions when the obstetrician cannot manage GERD symptoms effectively and for the well being of the patient and the foetus a referral  is made to the gastro-enterologist.

Here are a few Indications for referral.

Sometimes vomiting can be so severe that the patient loses weight. In pregnancy, regular weight gain is expected. Not gaining weight is not necessarily a problem but losing weight rings alarm bells for the Obstetrician. Certainly weight should not drop below the weight before the pregnancy.

Severe GERD may lead to mal-nutrition in pregnancy. A pregnant woman is eating for two. Mal-nutrition is not only harmful to her but there is serious risk to vital foetal development and growth.

Sometimes acid reflux symptoms get worse during the night and the sufferer ends up with little sleep or none at all. Adequate rest is an important part of a healthy pregnancy. When this is a problem, the Gastro-enterologist input is needed.

There are other conditions that warrants urgent referral. Difficulty swallowing is one. It suggests a possible stricture. Haematemesis is vomiting up of blood. When this happens in GERD patients, it points to bleeding from ulcerated lesions of esophagitis.

Dr. Phil Hariram.